Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-1735479
Telemonitoring with Electronic Devices in Patients with a Single Ventricle Anatomy
![](https://www.thieme-connect.de/media/thoracic/2021S03/lookinside/thumbnails/10-1055-s-0041-1735479_216204pcc-1.jpg)
Abstract
Background A growing number of patients with a single ventricle anatomy, who had a Fontan palliation as a child, are now reaching adulthood. Many need an epimyocardial pacemaker system with an optional telemonitoring (TM) unit, which evaluates the collected data and sends it via Internet to the patient's physician. There are no data on the reliability and clinical relevance of these systems in this patient group.
Methods We analyzed data in 48 consecutive patients (mean age 18 years, standard deviation 9 years) with a Fontan or Fontan-like palliation who received a cardiac implantable electronic device with a TM unit from Biotronik (Home Monitoring) or Medtronic (CareLink) between 2005 and 2020 with regard to the reliability and clinical relevance of the downloaded data.
Results The observation period was from 4 months to 14 years (mean 7 years, standard deviation 3.9 years). A total of 2.9 event messages (EMs)/patient/month and 1.3 intracardiac electrogram recordings/patient/month were received. Two patients died during follow-up. The combination of regularly arriving statistical data and 313 clinically relevant EMs led to the modification of antiarrhythmic or diuretic medication, hospitalization with cardioversion or ablation, and cortisone therapy to avoid exit block in 21 (44%) patients.
Conclusion TM is an instrument to receive functional and physiologic parameters of our Fontan patients. It provides the ability to respond early for signs of system failure, or arrhythmia, even if the patient is not experiencing any problems. It is a useful tool to manage this difficult patient population without frequent hospital visits.
Keywords
Fontan circulation - single ventricle - pacemaker - AICD - total cavopulmonary circulation - epimyocardial - implantationPublication History
Received: 14 February 2021
Accepted: 02 July 2021
Article published online:
10 December 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Rychik J, Atz AM, Celermajer DS. et al; American Heart Association Council on Cardiovascular Disease in the Young and Council on Cardiovascular and Stroke Nursing. Evaluation and management of the child and adult with Fontan circulation: a scientific statement from the American Heart Association. Circulation 2019;140(06CIR0000000000000696
- 2 Gewillig M, van de Bruaene A. FUELing the search for medical therapies in late Fontan failure. Circulation 2020; 141 (08) 652-654
- 3 Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971; 26 (03) 240-248
- 4 Veldtman GR, Opotowsky AR, Wittekind SG. et al. Cardiovascular adaptation to the Fontan circulation. Congenit Heart Dis 2017; 12 (06) 699-710
- 5 Gewillig M, Goldberg DJ. Failure of the Fontan circulation. Heart Fail Clin 2014; 10 (01) 105-116
- 6 Khairy P, Van Hare GF, Balaji S. et al. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Heart Rhythm 2014; 11 (10) e102-e165
- 7 Huntley GD, Deshmukh AJ, Warnes CA, Kapa S, Egbe AC. Longitudinal outcomes of epicardial and endocardial pacemaker leads in the adult Fontan patient. Pediatr Cardiol 2018; 39 (07) 1476-1483
- 8 Helguera ME, Maloney JD, Woscoboinik JR. et al. Long-term performance of epimyocardial pacing leads in adults: comparison with endocardial leads. Pacing Clin Electrophysiol 1993; 16 (3 Pt 1): 412-417
- 9 Zartner P, Handke R, Photiadis J, Brecher AM, Schneider MB. Performance of an autonomous telemonitoring system in children and young adults with congenital heart diseases. Pacing Clin Electrophysiol 2008; 31 (10) 1291-1299
- 10 Nagel B, Janousek J, Koestenberger M. et al. Remote monitoring leads to early recognition and treatment of critical arrhythmias in adults after atrial switch operation for transposition of the great arteries. Circ J 2014; 78 (02) 450-456
- 11 Sharma V, Burkhart HM, Cetta F, Hagler DJ, Phillips SD, Dearani JA. Fontan conversion to one and one half ventricle repair. Ann Thorac Surg 2012; 94 (04) 1269-1274 , discussion 1274
- 12 Janoušek J, Kovanda J, Ložek M. et al. Cardiac resynchronization therapy for treatment of chronic subpulmonary right ventricular dysfunction in congenital heart disease. Circ Arrhythm Electrophysiol 2019; 12 (05) e007157
- 13 Atz AM, Zak V, Mahony L. et al; Pediatric Heart Network Investigators. Longitudinal outcomes of patients with single ventricle after the Fontan procedure. J Am Coll Cardiol 2017; 69 (22) 2735-2744
- 14 Williams RV, Travison T, Kaltman JR. et al; Pediatric Heart Network Investigators. Comparison of Fontan survivors with and without pacemakers: a report from the Pediatric Heart Network Fontan Cross-Sectional Study. Congenit Heart Dis 2013; 8 (01) 32-39
- 15 Gewillig M, Brown SC, van de Bruaene A, Rychik J. Providing a framework of principles for conceptualising the Fontan circulation. Acta Paediatr 2020; 109 (04) 651-658
- 16 Koole MAC, Kauw D, Winter MM. et al. First real-world experience with mobile health telemonitoring in adult patients with congenital heart disease. Neth Heart J 2019; 27 (01) 30-37
- 17 Balaji S, Daga A, Bradley DJ. et al. An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations. J Thorac Cardiovasc Surg 2014; 148 (02) 576-581
- 18 Tsao S, Deal BJ, Backer CL, Ward K, Franklin WH, Mavroudis C. Device management of arrhythmias after Fontan conversion. J Thorac Cardiovasc Surg 2009; 138 (04) 937-940
- 19 Zartner PA, Mini N, Vergnat M, Momcilovic D, Schneider MB, Dittrich S. Performance of epimyocardial leads in patients with a single ventricle circulation. Pacing Clin Electrophysiol 2021; 44 (05) 903-910